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Association between systemic treatment with immune checkpoint inhibitor therapy in renal cell carcinoma and reduced

Mark Damante1, Kristin Huntoon1, David Gibbs2

  • 11Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.

Neurosurgical Focus
|August 1, 2023
PubMed
Abstract

Insights

Immune checkpoint inhibitors (ICIs) improve survival for metastatic renal cell carcinoma (RCC) patients with brain metastases (BMs). ICIs also reduce the risk of developing BMs in RCC patients.

Area of Science:

  • Medical Oncology
  • Immunotherapy
  • Nephrology

Background:

  • Immune checkpoint inhibitors (ICIs) show established efficacy in metastatic renal cell carcinoma (RCC) without brain metastases (BMs).
  • Patients with BMs were historically excluded from ICI trials, leaving their efficacy and impact on BM development unclear.
  • Understanding ICI's role in RCC with BMs is crucial for treatment optimization.

Purpose of the Study:

  • To compare the efficacy of ICIs versus targeted therapies in treating patients with RCC and BMs.
  • To evaluate the risk of BM development in metastatic RCC patients treated with ICIs compared to targeted therapies.
  • To assess the impact of ICIs on overall survival in RCC patients with and without BMs.

Main Methods:

  • Retrospective single-center review of 425 metastatic RCC patients (2011-2018).
  • Analysis of patients treated with ICIs and/or targeted therapies, focusing on demographics, treatments, overall survival (OSRCC and OSBM), and BM development.
  • Statistical analysis included Fisher's exact test, Kaplan-Meier curves, and log-rank tests.

Main Results:

  • ICIs improved overall survival from RCC diagnosis (OSRCC) and from BM diagnosis (OSBM) in patients with BMs.
  • The rate of BM development was significantly lower in patients treated with ICIs (8.0%) compared to targeted therapy (17.6%).
  • 1-, 2-, and 5-year survival rates for patients with BMs treated with ICIs were 93.9%, 81.8%, and 62.6%, respectively.

Conclusions:

  • Immune checkpoint inhibitors are associated with improved survival outcomes in metastatic RCC patients with brain metastases.
  • ICI treatment is linked to a reduced probability of developing brain metastases in metastatic RCC.
  • Further prospective trials are warranted to define the optimal use of ICIs for RCC brain metastases.
Keywords:
brain metastasischeckpoint inhibitormolecular targeted therapyrenal cell carcinoma

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